Pulmonary rehabilitation

Pulmonary rehabilitation
Intervention
Other codes None universally accepted[1]

Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities.[2] In general, pulmonary rehabilitation refers to a series of services that are administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient.[3] Pulmonary rehabilitation may be carried out in a variety of settings, depending on the patient's needs, and may or may not include pharmacologic intervention.[4]

Medical uses

The NICE clinical guideline on chronic obstructive pulmonary disease states that “pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD (usually MRC [Medical Research Council] grade 3 and above)”.[5] It is indicated not only in patients with COPD, but also in:

It appears not to be harmful and may be helpful for interstitial lung disease.[6]

Aim

Benefits

Weaknesses addressed

Background

Pulmonary rehabilitation is generally specific to the individual patient, with the objective of meeting the needs of the patient. It is a broad program and may benefit patients with lung diseases such as chronic obstructive pulmonary disease (COPD), sarcoidosis, idiopathic pulmonary fibrosis (IPF) and cystic fibrosis, among others. Although the process is focused on the rehabilitation of the patient him/herself, the family is also involved. The process typically does not begin until a medical exam of the patient has been performed by a licensed physician.[4]

The setting of pulmonary rehabilitation varies by patient; settings may include inpatient care, outpatient care, the office of a physician, or the patient's home.[4]

Although there are no universally accepted procedure codes for pulmonary rehabilitation, providers usually use codes for general therapeutic processes.[1]

The goal of pulmonary rehabilitation is to help improve the well-being and quality of life of the patient and their families. Accordingly, programs typically focus on several aspects of the patient's recovery and can include: - Medication management - Exercise training - Breathing retraining - Education about the patient's lung disease and how to manage it - Nutrition counseling - Emotional support

Pharmacologic intervention

Medications may be used in the process of pulmonary rehabilitation including: Anti-inflammatory agents (inhaled steroids), Bronchodilators, Long-acting bronchodilators, Beta-2 agonists, Anticholinergic agents, Oral steroids, Antibiotics, Mucolytic agents, Oxygen therapy, or Preventative therapy (i.e., Vaccination).

Exercise

Exercise is the cornerstone of pulmonary rehabilitation programs. Although, exercise training does not directly improve lung function, it causes several physiological adaptations to exercise which can improve physical condition. There are three basic types of exercises to be considered. Aerobic exercise tends to improve the body's ability to use oxygen by decreasing the heart rate and blood pressure. Strengthening or resistance exercises can help build strength in the respiratory muscles. Stretching and flexibility exercises like yoga and Pilates can enhance breathing coordination. As exercise can trigger shortness of breath, it is important to build up the level of exercise gradually under the supervision of health care professionals (e.g., physiotherapist, exercise physiologist, doctor). Additionally pursed lip breathing can be used to increase oxygen level in patient's body. Breathing games can be used to motivate patients to learn pursed lip breathing technique.

Guidelines

Clinical practice guidelines have been issued by various regulatory authorities.

Contraindications

The exclusion criteria for pulmonary rehabilitation consists of the following:

Outcome

The clinical improvement in outcomes due to pulmonary rehabilitation is measurable through:

References

  1. 1 2 Sweeney, Greg. "Pulmonary Rehabilitation". Retrieved 8 June 2011.
  2. Nici L; Donner C; Wouters E; Zuwallack R; Ambrosino N; Bourbeau J; et al. (2006). "American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation". Am J Respir Crit Care Med 173 (12): 1390–413. doi:10.1164/rccm.200508-1211ST. PMID 16760357.
  3. Sharma, Sat. "Pulmonary Rehabilitation". eMedicine. Retrieved 8 June 2011.
  4. 1 2 3 "Pulmonary Rehabilitation". AARC Clinical Practice Guideline. Respiratory Care (journal). Retrieved 8 June 2011.
  5. 1 2 CG101 Chronic obstructive pulmonary disease (update): full guideline
  6. Dowman, L; Hill, CJ; Holland, AE (Oct 6, 2014). "Pulmonary rehabilitation for interstitial lung disease.". The Cochrane database of systematic reviews 10: CD006322. doi:10.1002/14651858.CD006322.pub3. PMID 25284270.
  7. Griffiths, T L; Phillips, C J; Davies, S; Burr, M L; Campbell, I A (30 September 2001). "Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme". Thorax 56 (10): 779–784. doi:10.1136/thorax.56.10.779. PMC 1745931. PMID 11562517.
  8. Güell, R; Casan, P; Belda, J; Sangenis, M; Morante, F; Guyatt, GH; Sanchis, J (April 2000). "Long-term effects of outpatient rehabilitation of COPD: A randomized trial.". Chest 117 (4): 976–83. doi:10.1378/chest.117.4.976. PMID 10767227.
  9. Foglio, K.; Bianchi, L.; Bruletti, G.; Battista, L.; Pagani, M.; Ambrosino, N. (Jan 1999). "Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction". The European respiratory journal 13 (1): 125–32. doi:10.1183/09031936.99.13112599. PMID 10836336.
  10. 1 2 3 Killian, Kieran J.; Leblanc, Pierre; Martin, David H.; Summers, Edith; Jones, Norman L.; Campbell, E. J. Moran (1 October 1992). "Exercise Capacity and Ventilatory, Circulatory, and Symptom Limitation in Patients with Chronic Airflow Limitation". American Review of Respiratory Disease 146 (4): 935–940. doi:10.1164/ajrccm/146.4.935. PMID 1416421.
  11. 1 2 Bernard, Sarah; LeBlanc, Pierre; Whittom, Francois; Carrier, Guy; Jobin, Jean; Belleau, Roger; Maltais, Francois (Aug 1998). "Peripheral muscle weakness in patients with chronic obstructive pulmonary disease". Am J Respir Crit Care Med 158 (2): 629–34. doi:10.1164/ajrccm.158.2.9711023. PMID 9700144.
  12. Ries, AL.; Bauldoff, GS.; Carlin, BW.; Casaburi, R.; Emery, CF.; Mahler, DA.; Make, B.; Rochester, CL.; Zuwallack, R. (May 2007). "Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines". Chest 131 (5 Suppl): 4S–42S. doi:10.1378/chest.06-2418. PMID 17494825.
  13. British Thoracic Society Standards of Care Subcommittee on Pulmonary Rehabilitation (31 October 2001). "Pulmonary rehabilitation". Thorax 56 (11): 827–834. doi:10.1136/thorax.56.11.827. PMC 1745955. PMID 11641505.
  14. CTS 2010 Guideline
  15. Pulmonary rehabilitation service for patients with COPD
  16. Pulmonary rehabilitation
  17. Jones, Paul W.; Harding, G; Wiklund, I; Berry, P; Tabberer, M; Yu, R; Leidy, NK (1 July 2012). "Tests of the Responsiveness of the COPD Assessment Test Following Acute Exacerbation and Pulmonary Rehabilitation<alt-title alt-title-type="short">COPD Assessment Test Responsiveness</alt-title>". CHEST Journal 142 (1): 134–40. doi:10.1378/chest.11-0309. PMID 22281796.
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